Evaluation of a Care Coordination/Home-Telehealth Program for Veterans with Diabetes

Abstract

We evaluated a Veterans Health Administration (VHA) care coordination/ hometelehealth (CC/HT) programon the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period postenrollment and also examined self-reported HRQL at enrollment and 1 year later. Multivariate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design.

Keywords

diabetes coordinated care home-telehealth

Get full access to this article

View all access options for this article.

References

Boyle, J. P. , Honeycutt, A. A. , Narayan, K. M. , Hoerger, T. J. , Geiss, L. S. , Chen, H. , et al. (2001). Projection of diabetes burden through 2050. Diabetes Care, 24, 1936-1940.

Cheery, J. C. , Dryden, K. , Kobb, R. , Hilsen, P. ,& Nedd, N. (2003). Opening a window of opportunity through technology and coordination: A multisite case study. Telemedicine Journal and e-Health, 9, 265-271.

Chumbler, N. R. , Mann, W. C. , Wu, S. , Schmid, A. ,& Kobb, R. (2004). The association of hometelehealth use and care coordination with improvement of functional and cognitive functioning in frail elderly men. Telemedicine Journal and e-Health, 10, 129-137.

Chumbler, N. R. , Neugaard, B. , Kobb, R. , Ryan, P. , Qin, H. , & Joo, Y. (2005). An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. Journal of Telemedicine and Telecare, 11, 150-156.

Congressional Budget Office . (2004). An analysis of the literature on disease management programs. Washington, DC: Author.

Davidson, R. A. , Giancola, A. , Gast, A. , Ho, J. ,& Waddell, R. (2003). Evaluation ofACCESS, a primary care program for indigent patients: Inpatient and emergency room utilization. Journal of Community Health, 28, 59-64.

Kazis, L. (2000). The Veterans SF-36 Health Status Questionnaire: Development and application in the Veterans Health Administration. Monitor, 5, 1-2, 13-14.

Kazis, L. , Miller, D. , Clark, J. , Skinner, K. , Lee, A. , Rogers, W. , et al. (1998). Health-related quality of life in patients served by the Department of Veterans Affairs. Archives of Internal Medicine, 158, 626-632.

Kazis, L. , Ren, X. S. , Lee, A. , Skinner, K. , Rogers, W. , Clark, J. , et al. (1999). Health status inVA patients: Results from the Veterans Health Study. American Journal of Medical Quality, 14, 28-38.

10.

Kobb, R. , Hoffman, N. , Lodge, R. , & Kline, S. (2003). Enhancing elder chronic care through technology and care coordination: Report from a pilot. Telemedicine Journal and E-Health, 9(2), 189-195.

11.

Krein, S. L. , Hayward, R. A. , Pogach, L. , & BootsMiller, B. J. (2000). Department of Veterans Affairs' Quality Enhancement Research Initiative for diabetes mellitus. Medical Care, 38(QUERI Suppl), I-38-I-48.

12.

Meyer, M. , Kobb, R. , & Ryan, P. (2002). Virtually healthy: Chronic disease management in the home. Disease Management, 5, 87-94.

13.

Perlin, J. B. , Kolodner, R. M. , & Roswell, R. H. (2004). The Veterans Health Administration: Quality, value, accountability, and information as transforming strategies for patientcentered care. American Journal of Managed Care, 10(part 2), 828-836.

14.

Piette, J. D. , Weinberger, M. , Kraemer, F. B. ,& McPhee, S. J. (2001). Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs health care system: A randomized controlled trial. Diabetes Care, 24, 202-208.

15.

Posavac, E. J. , & Carey, R. G. (1997). Program evaluation: Methods and case studies(5th ed.). Upper Saddle River, NJ: Prentice Hall.

16.

Ren, X. S. , Skinner, K. , Lee, A. , & Kazis, L. (1999). Social support, social selection and selfassessed health status: Results from the Veterans Health Study in the United States. Social Science and Medicine, 48, 1721-1734.

17.

Ryan, P. , Kobb, R. ,& Hilsen, P. (2003). Making the right connection: Matching patients to technology. Telemedicine Journal and E-Health, 9, 81-88.

18.

Tinkelman, D. , & Wilson, S. (2004). Asthma disease management: Regression to the mean or better? American Journal of Managed Care, 10, 948-954.